血栓弹力图用于血液肿瘤患者预防性输注血小板的效果观察

Effect of Thrombelastography in Prophylactic Platelet Transfusion in Patients with Hematologic Malignancy

目的探讨血栓弹力图用于血液肿瘤患者预防性输注血小板的效果。方法按照出血症状将40例患者划分为观察组和对照组,观察组为18例出血患者,对照组为22例未出血患者,对两组患者的血栓弹力图和血小板计数进行检测。清晨空腹抽取患者肘部静脉血,进行血凝四项检测。结果观察组患者的血小板计数和血栓弹力图最大振幅分别为(8. 36±4. 12)×10^9/l和(24. 78±5. 19) mm,明显低于对照组血小板减少计数(25. 29±10. 58)×10^9/l和血栓弹力图最大振幅(42. 18±6. 32) mm,差异明显具有统计学意义;两组患者血凝四项检测结果中,观察组PT、APTT、TT和FIB水平与对照组比较差异不大,无统计学意义;以最大振幅≤40 mm、血小板计数≤20×10^9/l为临界值,最大振幅与血小板计数敏感性相同均为100%,差异无统计学意义,特异性最大振幅远远高于血小板计数,差异明显具有统计学意义。结论血栓弹力图用于血液肿瘤患者预防性输注血小板中效果显著,能够综合测定出血小板的凝血活性,血栓弹力图在预防性输注血小板中特异度要远远高于血小板减少,有着较高的预测价值,值得在临床中推广应用。

Objective To explore the effect of thrombelastography in prophylactic platelet transfusion in patients with hematologic malignancy. Methods According to the bleeding symptoms,40 patients with hematologic malignancy were divided into the observation group and the control group,there were 18 patients with bleeding in the observation group and 22 patients with non-bleeding in the control group,The thrombelastography and platelet counts of the 2 groups were measured. Venous blood of elbow was drawn on an empty stomach in the morning,then which were performed four Blood coagulation indexes testing. Results Platelet counts and thrombelastography of the observation group were( 8. 36 ± 4. 12) 10~9/l and( 24. 78 ± 5. 19) mm,respectively,those were significantly lower than Platelet counts( 25. 29 ± 10. 58) and thrombelastography( 42. 18 ± 6. 32) of the control group;In the results of four Blood Coagulation Indexes Testing,levels of PT,APTT,TT and FIB of the observation group were not significantly differences than those of the control group. Maximum amplitude was less than or equal to 40 mm,platelet counts was less than or equal to 20 × 10~9/l,those were the threshold. Sensitivity of maximum amplitude was 100%,which was same as sensitivity of platelet counts;Specific maximum amplitude was much higher than platelet counts. Conclusion The effect of thrombelastography in prophylactic platelet transfusion in patients with hematologic malignancy has remarkable effect,which can synthetically measure coagulation activity of platelet,specificity of thrombelastography in prophylactic platelet transfusion is much higher than thrombocytopenia,which has high predictive value,and is worth popularizing in clinical practice.